Provider Demographics
NPI:1477722700
Name:CENTER FOR NEUROLOGY & STROKE
Entity Type:Organization
Organization Name:CENTER FOR NEUROLOGY & STROKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:AVINASH
Authorized Official - Middle Name:
Authorized Official - Last Name:KHATTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-335-0300
Mailing Address - Street 1:6036 N 19TH AVE
Mailing Address - Street 2:SUITE 506
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2106
Mailing Address - Country:US
Mailing Address - Phone:602-335-0300
Mailing Address - Fax:602-249-3118
Practice Address - Street 1:13062 WEST MCDOWELL ROAD
Practice Address - Street 2:SUITE C1
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323
Practice Address - Country:US
Practice Address - Phone:602-406-3605
Practice Address - Fax:602-249-3118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ380092084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
65149OtherMEDICARE ID